Firmly in the saddle? A scoping review of the role of consultation-liaison clinicians as gatekeepers.

This scoping review examines psychiatric gatekeeping (PG) in somatic care, its prescribed settings and perceived role. Considered were English peer-reviewed articles published between January 1994 and January 2025 with the terms "psychiatric gatekeeper-s" and/or "gatekeeping" in the title, abstract, or full text, addressing the adult population. The initial search retrieved 4398 publications of which 34 were included. Citation searching yielded an additional 12 articles. Most articles discussed PG in gender-affirming medical care (GAMC; N = 31), followed by medical assistance in dying (MAD; N = 7), and other settings (N = 8). Seventeen were empirical studies. Authors highlight the negative clinical, ethical, and political effects of gatekeeping in GAMC and MAD. In other settings, the lack of evidence for outcome prediction and clinical benefit, as well as role confusion, are emphasized regarding PG. Results are discussed from clinical, scientific, context-related, ethical, and economic, political and societal perspectives.